Pyogenic liver abscesses are usually secondary to peritonitis due to that subsequently spread to liver via the portal circulation or bile ducts. Other common form is as a result of hematogenous seeding in the setting of sepsis.
Clinical manifestations: fever, abdominal pain, nausea, vomiting, anorexia, weight loss and malaise.
Diagnosis of pyogenic liver abscess is confirmed by imaging (ultrasound r CT) followed by aspiration and culture of the abscess material. Most pyogenic liver abscesses are polymicrobial. Serology is useful in distinguishing pyogenic abscess from an amebic abscess.
Indications for drainage(less than 5cm usually aspiration is sufficient, greater than 5cm usually need in dwelling catheter):
- Loculated abscesses
- Abscesses with viscous contents obstructing drainage catheter
- Underlying disease requiring primary surgical management
- Inadequate response to percutaneous drainage within seven days
- Multiple abscesses (depends on number, position, and size)
Antibiotics:
A total of 4-6 weeks of therapy is needed.
Options for empiric gram-negative and anaerobic coverage include:
1) Penicillin derivatives: Ampicillin-sulbactam, Piperacillin/tazobactam or Ticarcillin-clavulanate
2) Cephalosporins: Ceftriaxone with metronidazole
3) Fluoroquinolone: Ciprofloxacin or Levofloxacin with metronidazole
4) Carbapenems: Imipenem, Meropenem or Ertapenem
10:43 AM
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